Dear Doctor, 

I am 25 years old and have had backache for three years. I have tried all medications in vain. What is the problem?

JP

Dear JP,

Did the backache start suddenly? Does it occur intermittently with some activity like bending, walking, e.t.c. Is it present constantly and is increasing in intensity. Are there abnormal sensations present around in back, thighs or legs along with the pain?

Trauma to the back is one of the most common causes of back pain in a young adult. The injury can cause rupture of the soft tissues or muscles causing persistent pain, which is aggravated by bending or stretching of the back. Intervertebral disc herniation is yet another cause of chronic backache in a young adult. Here an intervertebral disc protrudes in the space below. It causes pain. If nerves present in the space are compressed, there can be abnormal sensations like tingling, feeling more hot or cold in the affected part. Soft tissue injury or disc herniation both occur due to activities such as lifting or pushing heavy weight, playing strenuous games, undue bending at back, e.t.c. back pain. The muscle fibers of back may be stretched unduly during pulling or bending of back, causing pain.

Backpain can be one of the manifestations of mental or physical stress.

Infections or tumors of the backbone cause persistent backache. But apart from the pain, there would be associated fever and loss of appetite. These diseases can also cause destruction of the backbone causing abnormal postures. Infections like those of the urinary tract or pelvic organs may result in low backache as one of the manifestations.

Diagnosis of the cause of back pain is usually done by imaging techniques such as computerised tomography (C.T. scan) or MRI (magnetic resonance imaging). Pain killers provide relief from pain, but do not correct the underlying abnormality. In cases of injury of muscles or soft tissue or disc herniation, bed rest in supine position for some days helps in healing and pain reduction. Movements should be started and increased gradually. One should avoid lifting or pushing heavy weights. The back should be kept straight always and bending should be avoided. Sitting with support to the back as in straight back chairs, sleeping on a hard bed, provides rest to the back and helps in improving the pain. Surgical intervention is considered only if the pain is very severe and disabling.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital